Surgical Strategy for Resecting Hepatocellular Carcinoma in the Caudate Lobe: Isolated or Combined Lobectomy? A Single-Center Study and Meta-Analysis

Figures & data

Figure 1 Flow diagram of systematic review.

Table 1 Baseline Characteristics

Variable	Before Propensity Matching			After Propensity Matching
	CCL Group (n = 11)	ICL Group (n = 17)	P value	CCL Group (n = 6)	ICL Group (n = 6)	P value
Demographics
Age, years	58.0 (43.0–70.0)	56.0 (41.0–78.0)	0.479	60.0 (51.0–65.0)	56.5 (50.0–63.0)	0.372
Gender			0.269			0.546
Female	3 (27.3)	1 (5.9)		3 (50.0)	1 (16.7)
Male	8 (72.7)	16 (94.1)		3 (50.0)	5 (83.3)
Hepatitis B virus infection			0.387			0.242
Absent	5 (45.5)	5 (29.4)		4 (66.7)	1 (16.7)
Present	6 (54.5)	12 (70.6)		2 (33.3)	5 (83.3)
Liver cirrhosis			0.577			0.558
Absent	7 (63.6)	9 (52.9)		4 (66.7)	3 (50.0)
Present	4 (36.4)	8 (47.1)		2 (33.3)	3 (50.0)
Alanine aminotransferase, U/L	33.10 (11.4–188.2)	33.9 (11.3–107.5)	0.430	22.4 (12.6–34.1)	30.4 (11.3–58.9)	0.485
Aspartate aminotransferase, U/L	33.2 (11.5–167.7)	33.9 (17.0–110.1)	0.586	28.6 (11.5–44.4)	26.6 (17.0–63.6)	0.818
Bilirubin, μmol/L	14.8 (9.2–38.0)	14.8 (6.6–35.3)	0.881	12.3 (9.2–25.5)	14.0 (12.1–30.3)	0.258
Albumin, g/L	40.4 (34.4–49.2)	44.6 (34.0–53.2)	0.119	41.8 (34.4–49.2)	42.8 (35.9–49.9)	0.699
Tumor variables
Alpha-fetoprotein level, ng/mL	135.5 (1.8–1210.0)	415.1 (1.2–1210.0)	0.515	9.4 (1.8–252.0)	102.3 (1.8–1210.0)	0.589
Tumor size, cm			0.048			1.000
≤ 3	1 (9.1)	9 (52.9)		0 (0.0)	0 (0.0)
3–5	6 (54.5)	6 (35.3)		4 (66.7)	4 (66.7)
>5	4 (36.4)	2 (11.8)		2 (33.3)	2 (33.3)
Tumor number			0.544			1.000
Single	8 (72.7)	14 (82.4)		6 (100.0)	5 (83.3)
Multiple	3 (27.3)	3 (17.6)		0 (0.0)	1 (16.7)
Vascular invasion			0.009			1.000
None	4 (36.4)	11 (64.7)		4 (66.7)	4 (66.7)
Microvascular	2 (18.1)	6 (35.3)		2 (33.3)	2 (33.3)
Macrovascular	5 (45.5)	0 (0.0)		0 (0.0)	0 (0.0)
Edmondson grade			0.184			1.000
Grade I–II	5 (45.5)	12 (70.6)		4 (66.7)	5 (83.3)
Grade III–IV	6 (54.5)	5 (29.4)		2 (33.3)	1 (16.7)
Surgical parameters
Blood loss, mL	450 (200–2500)	150 (50–2500)	0.005	425 (200–2500)	200 (100–600)	0.110
Blood transfusion	6 (54.5)	5 (29.4)	0.184	3 (50.0)	2 (33.3)	0.558
Operation time, min	315 (130–445)	130 (69–361)	<0.001	293 (130–420)	155 (90–300)	0.069
Negative surgical margin	11 (100.0)	12 (70.6)	0.125	6 (100.0)	5 (83.3)	1.000
Post-operative data
In-hospital mortality	0 (0.0)	0 (0.0)	1.000	0 (0.0)	0 (0.0)	1.000
Overall complications	5 (45.5)	5 (29.4)	0.387	4 (66.7)	2 (33.3)	0.248
Pleural effusion	2 (18.2)	0 (0.0)	0.146	1 (16.7)	0 (0.0)	1.000
Ascites	2 (18.2)	0 (0.0)	0.146	1 (16.7)	0 (0.0)	1.000
Bile leakage	1 (9.1)	1 (5.9)	1.000	1 (16.7)	1 (16.7)	1.000
Abdominal collection	0 (0.0)	3 (17.6)	0.258	0 (0.0)	1 (16.7)	1.000
Thromboembolic disease	2 (18.1)	0 (0.0)	0.146	2 (33.3)	0 (0.0)	0.455
Wound infection	0 (0.0)	1 (5.9)	1.000	0 (0.0)	0 (0.0)	1.000
Hospital stays, days	16 (11–25)	11 (7–15)	<0.001	16 (11–25)	13 (10–14)	0.026

Note: Continuous variables reported as median (range) and categorical variables reported as number (percentage).

Abbreviations: CCL, combined caudate lobectomy; ICL, isolated caudate lobectomy.

Figure 2 Kaplan-Meier survival estimates stratified by surgical strategy in the original and well-matched cohorts. Kaplan–Meier estimates of overall survival (A) and recurrence‐free survival (B) among patients who underwent CCL versus ICL before propensity score matching; overall survival (C) and recurrence-free survival (D) among patients who underwent CCL versus ICL after propensity score matching.

Table 2 Prognostic Variables

Variable	Survival				Recurrence
	Univariate		Multivariate		Univariate		Multivariate
	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value	HR (95% CI)	P value
Age	0.987 (0.911–1.069)	0.752			0.990 (0.936–1.046)	0.713
Male	0.598 (0.127–2.820)	0.515			1.600 (0.366–7.005)	0.533
Hepatitis B virus infection	2.349 (0.498–11.07)	0.280			2.173 (0.778–6.070)	0.138
Alpha-fetoprotein level	1.000 (0.998–1.001)	0.718			1.000 (0.999–1.001)	0.373
Alanine aminotransferase	1.005 (0.987–1.023)	0.605			0.997 (0.982–1.012)	0.671
Aspartate aminotransferase	1.005 (0.987–1.024)	0.583			0.997 (0.982–1.013)	0.719
Bilirubin	1.089 (1.001–1.185)	0.046	1.082 (0.997–1.175)	0.060	1.045 (0.982–1.112)	0.169
Albumin	0.971 (0.863–1.092)	0.619			1.008 (0.924–1.100)	0.852
Tumor size	1.178 (0.957–1.451)	0.122			0.984 (0.808–1.199)	0.875
Multiple number	2.936 (0.726–11.87)	0.131			2.328 (0.815–6.654)	0.115
Surgical strategy (CCL vs ICL)	2.063 (0.593–7.176)	0.255			0.549 (0.194–1.557)	0.260
Negative surgical margin	0.850 (0.167–4.339)	0.836			0.772 (0.248–2.398)	0.674
Vascular invasion*	4.810 (1.218–19.00)	0.025	4.788 (1.176–19.50)	0.029	4.726 (1.795–12.44)	0.002	4.039 (1.293–12.61)	0.016
Liver cirrhosis	2.233 (0.620–8.041)	0.219			2.664 (1.041–6.821)	0.041	1.322 (0.446–3.920)	0.615
Edmondson grade (III–IV vs I–II)	1.298 (0.375–4.494)	0.681			1.164 (0.471–2.876)	0.742

Note: *Including micro- and macro-vascular invasion.

Abbreviations: HR, hazard ratio; CI, confidence interval; CCL, combined caudate lobectomy; ICL, isolated caudate lobectomy.

Table 3 Summary of Reports on Oncological Outcomes of Resected Caudate HCC

Authors	Published Year	Country	CCL	ICL	Overall Survival		Recurrence-Free Survival
					HR	95% CI	HR	95% CI
Shimada M.	1994	Japan	2	7	0.987	0.083–11.791	0.527	0.058–4.757
Yang	1996	China	4	2	0.006	6.96E-11-5.00E+5	0.577	0.036–9.297
Yamamoto	2004	Japan	8	7	3.287	0.358–30.168	1.128	0.301–4.221
Tanaka	2005	Japan	14	6	0.640	0.050–8.940	0.500	0.080–3.220
Peng	2006	China	20	19	NA	NA	NA	NA
Sakoda	2009	Japan	6	6	NA	NA	NA	NA
Liu	2012	China	20	16	0.370	0.140–0.980	0.390	0.170–0.940
Zhou	2013	China	10	13	1.21	0.20–7.21	NA	NA
Shimada S.	2019	Japan	12	27	NA	NA	NA	NA
This study		China	11	17	2.063	0.593–7.176	0.549	0.194–1.557

Abbreviations: CCL, combined caudate lobectomy; ICL, isolated caudate lobectomy; HR, hazard ratio; CI, confidence interval; NA, not available.

Figure 3 Meta-analysis of overall survival between CCL and ICL groups for the treatment of caudate HCC. (A) Forest plot generated from meta-analysis of overall survival between CCL and ICL groups; (B) Egger’s test for the publication bias in the meta-analysis of overall survival between CCL and ICL groups; (C) Forest plot generated from meta-analysis of overall survival after excluding two low-quality studies.

Figure 4 Meta-analysis of recurrence-free survival between CCL and ICL groups for the treatment of caudate HCC. (A) Forest plot generated from meta-analysis of recurrence-free survival between CCL and ICL groups; (B) Egger’s test for the publication bias in the meta-analysis of recurrence-free survival between CCL and ICL groups; (C) Forest plot generated from meta-analysis of recurrence-free survival after excluding two low-quality studies.